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A condition marked by small sacs or pouches in the walls of a hollow organ, such as the colon. These sacs can become inflamed and cause a condition called diverticulitis.

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OBJECTIVE: To review the evidence of safety and effectiveness of endoscopic and surgical treatment of Zenker's diverticulum.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

A pharyngeal pouch is a pocket which can develop in the pharynx (throat), just above the entrance to the oesophagus (gullet). It may cause difficulty in swallowing, sensation of a lump in the throat and troublesome regurgitation of food. Food may become lodged in the pouch and this, as well as regurgitation, may lead to weight loss, hoarseness of voice and recurrent chest infections. A pharyngeal pouch is treated by surgery which may either be 'open' (through an incision in the neck) or 'endoscopic' (through the mouth). The review found no evidence to show which surgical method is more effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 20, 2005

This study was designed to compare rates of failure, revision and morbidity from endoscopic and open approaches as treatment for pharyngeal pouch. Systematic review was conducted using MEDLINE and PubMed databases. Search terms treatment, Zenker's, hypopharyngeal, pharyngeal, diverticulum, and pouch. There were no randomised clinical trials. Therefore, cohort and comparative studies with at least 10 patients in each arm, a follow-up of a least 12 months and reporting on all patients were included. Seventy-one studies met inclusion criteria. Diverticulectomy with or without cricopharyngeal myotomy comprised 33 studies (1,990 patients), and endoscopic stapler diverticulotomy was in 22 studies (1,089 patients). Failure of open and endoscopic approaches was 4.2 and 18.4 %, respectively, and corresponding complication rates were 11 and 7 %. Within endoscopic techniques, failure rates were 18.9 % for stapler diverticulotomy and 21.7 % for laser diverticulotomy. Corresponding complication rates were 4.3 and 7.9 %. Flexible endoscopy techniques have a higher failure (29 %) and overall complication rate (14.3 %). Most reported complications for transcervical techniques relate to the recurrent nerve (3.4 %) and salivary fistula (3.7 %) and for endoscopic group emphysema (3.0 %) and mediastinitis (1.2 %). Operation-related deaths were infrequent in both groups, but more frequent with open approach (0.9 vs. 0.4 %). Open approaches have more success but more complications than endoscopic techniques. Taking in account overall complications and failure rates, open approaches and stapler diverticulotomy yield different patterns, but are arguably comparable. In younger patients open approach is preferred, as well in patients with unfavourable anatomic conditions for endoscopic exposure. Flexible endoscopic techniques provide a suitable option for patients who do not tolerate general anaesthesia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

This poorly reported review assessed surgical approaches for patients with Zenker's diverticulum using evidence from case series. The authors' concluded that out-patient endoscopic staple diverticulostomy reduces the complication rate, operating time and convalescence time compared with other types of surgery. The quality of included studies was not assessed and since surgical techniques were not directly compared, any conclusions are tentative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

The authors of this review concluded that embolisation was most effective for treating massive lower gastrointestinal bleeding due to diverticular disease, but higher rates of re-bleeding were found in patients with non-diverticular disease. A more cautious conclusion may have been appropriate given the reliance upon limited data from small, retrospective observational studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

BACKGROUND: Diverticular disease of the colon is a common disorder, characterized by recurrent symptoms and complications such as diverticulitis, requiring hospital admissions and surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

This review concluded that treatment with rifaximin plus fibre supplementation was effective in obtaining symptom relief and could prevent more complications at one year in patients with symptomatic uncomplicated diverticular disease. This conclusion reflects the results presented, but the small number of included trials and the potential for missed data mean that it should be interpreted with some caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

PURPOSE: This systematic literature review was designed to summarize and compare the reported outcomes of one-stage and two-stage operations for the treatment of perforated diverticulitis with peritonitis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The authors concluded that compared to open resection, laparoscopic sigmoid resection was safe and had fewer postoperative surgical complications. The reliability of the conclusion is uncertain as the synthesis approach may have been inappropriate and few randomised controlled trials were included.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The review found that elective laparoscopic surgery appeared safe and appropriate compared to open surgery for sigmoid diverticular disease according to non-randomised evidence. The only randomised study supported this view but found that both interventions were associated with high overall morbidity. The authors' conclusions require some caution due to high heterogeneity for some analyses and risk of selection bias.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This review compared outcomes for patients undergoing laparoscopic versus open surgical resections for diverticular disease. Evidence is limited to a small number of comparative non-randomised trials that suggested outcomes for laparoscopic and open surgeries were in general equivalent. However, the authors failed to find any clinically applicable conclusions, owing to the absence of randomised controlled trials.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

The guideline covers men (18 and over) with a clinical working diagnosis of lower urinary tract symptoms (LUTS). Options for conservative, pharmacological, surgical, and complementary or alternative treatments are considered in terms of clinical and cost effectiveness.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010

This study found that the effectiveness of fibrin sealants do not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma.

Health Technology Assessment - NIHR Journals Library.

Version: December 2016

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2007

This guideline aims to provide advice on the assessment and management of children and young people with bedwetting. The guidance is applicable to children and young people up to 19 years with the symptom of bedwetting. It has been common practice to define enuresis as abnormal from 5 years and only to consider children for treatment when they are 7 years. While the prevalence of symptoms decreases with age the guideline scope did not specify a younger age limit in order to consider whether there were useful interventions that might be of benefit to children previously excluded from advice and services.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010

BACKGROUND: A PubMed search of the biomedical literature was carried out to systematically review the role of laparoscopy in colonic diverticular disease. All original reports comparing elective laparoscopic, hand-assisted, and open colon resection for diverticular disease of the colon, as well as original reports evaluating outcomes after laparoscopic lavage for acute diverticulitis, were considered. Of the 21 articles chosen for final review, nine evaluated laparoscopic versus open elective resection, six compared hand-assisted colon resection versus conventional laparoscopic resection, and six considered laparoscopic lavage. Five were randomized controlled trials.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

AIM: A meta-analysis was conducted to compare preservation with ligation of the inferior mesenteric artery (IMA) during sigmoidectomy for diverticular disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The authors concluded that laparoscopic sigmoid resection took longer to perform than open procedures, but was safe and had lower overall morbidity, earlier return of bowel function and shorter hospital stays. The reliability of the conclusion is uncertain as only one randomised controlled trial was included and the approach to synthesis of results appeared inappropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Study finds that faecal calprotectin can be a highly sensitive way of detecting inflammatory bowel disease (IBD); in most cases, a negative calprotectin test result rules out IBD, thereby sparing most people with irritable bowel syndrome from having to undergo invasive investigations, such as colonoscopy.

Health Technology Assessment - NIHR Journals Library.

Version: November 2013

To create a systematic synthesis of the published evidence about the prevalence of eight geriatric syndromes and their association with survival and institutionalization, and to provide a review of models that report survival in elderly populations.

Evidence Syntheses/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: July 2011

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